Zusammenfassung
Hintergrund
Aneurysmen der abdominellen Aorta mit Beteiligung von renoviszeralen Gefäßen benötigen eine komplexe endovaskuläre Ausschaltung. Die Herausforderung besteht, darin, die notwendige Fixation der Endoprothese bei fehlender Verankerungszone unter gleichzeitigem Erhalt der Perfusion des betroffenen Zielgefäßes zu gewährleisten.
Ziel der Arbeit
Überblick über Möglichkeiten und Grenzen der Chimney-Technik
Material und Methoden
Auswertung der aktuellen Literatur unter Einbeziehung eigener klinischer Ergebnisse.
Ergebnisse
Der Chimney-Graft verhindert die Einengung des Ostiums des Zielgefäßes durch den abdominellen Stentgraft, sorgt für eine regelrechte Perfusion des betroffenen Zielgefäßes und ermöglicht die Ausschaltung des Aneurysmas.
Schlussfolgerungen
Die ersten publizierten Erfahrungen zeigen vielversprechende Ergebnisse. Allerdings sind die Patientenzahlen noch zu gering und der Nachuntersuchungszeitraum kurz. Derzeit konzentriert sich das wissenschaftliche Interesse auf technische Details und die Evaluation der Langzeitergebnisse.
Abstract
Background
Complex abdominal aortic aneurysms with a hostile neck are very challenging. The sufficient exclusion of the aneurysm with additional perfusion of the renovisceral vessels represents a technically demanding situation. The use of fenestrated endoprostheses or chimney grafts allows a total endovascular solution for these pathologies. The chimney endovascular technique has gained increasing acceptance in recent years.
Aim
The objective of this article is to present the current status of the chimney endovascular technique in the treatment of complex abdominal aortic aneurysms with short hostile necks.
Material and methods
The study involved an evaluation of the current literature and the personal experience in a high volume center regarding vascular and endovascular techniques.
Results
The use of chimney grafts is safe and feasible and represents a valuable tool in the endovascular armamentarium.
Conclusion
The initial published experiences show very promising results; however, the number of patients is low and the follow-up period is short. Scientific interest is currently concentrating on technical details and the evaluation of long-term results.
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Literatur
Donas KP, Eisenack M, Panuccio G et al (2012) The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms. J Vasc Surg 56:285–290
Greenberg RK, Clair D, Srivastava S et al (2003) Should patients with challenging anatomy be offered endovascular aneurysm repair? J Vasc Surg 38:990–996
Criado FJ et al (2007) Chimney grafts and bare stents: aortic branch preservation revisitited. J Endovasc Ther 14:823–824
Bruen KJ, Feezor RJ, Daniels MJ et al (2011) Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 53:895–904
Coscas R, Kobeiter H, Desgranges P et al (2011) Technical aspects, current indications and results of chimney grafts for juxtarenal aortic aneurysms. J Vasc Surg 53:1520–1527
Donas KP, Torsello G, Austermann M et al (2010) Use of abdominal chimney grafts is feasible and safe: short-term results. J Endovasc Ther 17:589–593
Donas KP, Pecoraro F, Torsello G et al (2012) Use of chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks. J Vasc Surg 55:659–665
Donas KP, Pecoraro F, Bisdas T et al (2013) CT angiography at 24 months demonstrates durability of EVAR with the use of chimney grafts for pararenal aortic pathologies. J Endovasc Ther 20:1–6
Donas KP, Bisdas T, Austermann M et al (2013) The chimney technique has a complentary role in the endovascular repair of juxtarenal aneurysms: there is no need for paradigm shift but for accurate patient selection. J Endovasc Ther 20:584–587
Lachat M, Bisdas T, Rancic Z et al (2013) Chimney endografting for pararenal aortic pathologies using transfemoral access and the lift technique. J Endovasc Ther 20:492–497
Lachat M, Veith FJ, Pfammaer T et al (2013) Chimney and periscope grafts observed over 2 years after their us to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms. J Endovasc Ther 20:597–605
Lee JT, Greenberg JL, Dalman RL et al (2012) Early experience with the snorkel technique for juxtarenal aneurysms. J Vasc Surg 55:935–946
Mestres G, Uribe JP, García-Madrid C et al (2012) The best conditions for parallel stenting during EVAR. An Vitro Study. Eur J Vasc Endovasc Surg 44:468–473
Tolenaar JL, Zandvoort HL, Moll FL et al (2013) Technical considerations and results of chimney grafts for the treatment of juxtarenal aneurysms. J Vasc Surg 58:607–615
Massmann A, Serracini-Inglott F, Buecker A et al (2013) Endovascular aortic repair with the chimney technique using the ultra low-profile ovation stent-graft for juxtarenal aneurysms having small iliac access vessels. Cardiovasc Intervent Radiol (Epub ahead of print)
Antoniou GA, Snyth JV, Antoniou SA et al (2012) Endoleak is the Achilles‘ heel of the chimney technique for the treatment of complex aortic disease. Int Angiol 31:595–596
Pecoraro F, Pfammatter T, Mayer D et al (2011) Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms. J Endovasc Ther 18:642–649
Katsargyris A, Oikonomou K, Klonaris C et al (2013) Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift? J Endovasc Ther 20:159–169
Donas KP, Torsello G, Bisdas T et al (2012) Early outcomes for fenestrated and chimney endografts in the treatment of pararenal aortic pathologies are not significantly different: a systematic review with pooled data analysis. J Endovasc Ther 19(6):723–728
Einhaltung ethischer Richtlinien
Interessenkonflikt. K.P. Donas gibt an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Der Autor bedankt sich bei Frau Kristin Weiss und Arne Stachmann für die redaktionelle Bearbeitung des Artikels.
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Donas, K. Endovaskuläre Therapie beim abdominalen Aortenaneurysma mit „hostile neck“ – Möglichkeiten und Grenzen der Chimney-Technik. Gefässchirurgie 19, 205–211 (2014). https://doi.org/10.1007/s00772-013-1274-x
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DOI: https://doi.org/10.1007/s00772-013-1274-x